The Transgender Dictionary
A B C D E F G H I J K L M N O P Q R S T U V W X Y Z MISCELLANEOUS

Estrogen

(Also: oestrogen)

Table of Contents

Introduction

There are many terms used to refer to the administration of bioidentical estrogen such as; hormone replacement therapy (HRT), estrogen replacement therapy (ERT), and feminizing hormone therapy (FHT). Some of these terms, such as ERT, originate from estrogen treatments intended for cisgender women. The term that will be used here is gender affirming hormone therapy (GAHT). As is the nature of a dictionary for transgender topics, this page will be discussing estrogen therapy as it pertains to both transgender women, and the nonbinary folks who seek it out.

GAHT is sought out by many, many transfeminine people as a very important part of their transitions. For those who seek it out, undergoing a testosterone-based puberty is traumatizing, and a massive source of gender dysphoria. Undergoing estrogen-based GAHT is a great way for these people to reduce (or sometimes eliminate) gender dysphoria caused by having the wrong bodily features. For these people, undergoing the changes caused by estrogen is a massive source of gender euphoria. This treatment can greatly reduce depression, anxiety, and suicidal ideation related to gender dysphoria. Estrogen helps many transgender women look like their authentic selves, and heavily boosts self-confidence, self-esteem, energy, and happiness.

While estrogen has predictible effects as a feminizing hormone, please keep in mind that the exact presentation of its effects will vary from person to person. The main variables at play in regards to how the effects will appear are age and genetics. Just like cisgender women, a transgender woman on estrogen is still at the mercy of the passage of time and the genetics passed down from her parents - in terms of what her body will look like after prolonged exposure to the female range of estrogen. The only thing that you can be garunteed with estrogen based GAHT is that feminine traits will be induced while masculine traits are suppressed (with the help of anti-androgens).

If you are interested in pursuing GAHT, seek out an endocrinologist (a doctor who specilizes in hormones). If you feel as though this treatment is right for you, ask your primary care physician for a referral. If you are not interested in pursuing GAHT, but would still like to educate yourself on the topic, feel free to continue reading. If you come across terms that you do not understand, feel free to consult the alphabet menu buttons at the top of the page to find the relevant definitions.

Please keep in mind that not all transgender women seek out GAHT, either due to personal, financial, or medical reasons. This does not make them any less transgender. That being said, the rest of this page will be discussing the majority of transgender women who do seek out this treatment.

General Information

Estrogen is typically taken alongside a testosterone blocker. Sometimes its taken alongside progesterone to maximize feminizing effects. Overall, this hormonal treatment can help the world see the trans woman taking it as, well, a woman.

While estrogen can do many things it cannot make a deep voice no longer deep. For a trans woman to achieve a lighter voice (if she so desires), she will have to obtain vocal feminization surgery, or voice train.

The overall effects of estrogen will vary from person to person; depending on genetics, prior puberty, and age. A fairly universal effect of estrogen on transgender women is overall improved emotional wellbeing and self-confidence from having her body changed in the way she wanted it to change in the first place.

When taking estrogen, most doctors will do regular bloodwork to catch any potential problems (such as kidney or liver damage) if they were to occur.

The primary goal for an endocrinologist treating a transgender woman is decrease the testosterone levels of the patient into the normal female physiological range of 30–100 ng/dl without supraphysiological levels of estradiol (less than 200 pg/ml) by administering an antiandrogen (such as spironolactone) and estrogen. For the first year, patients are typically monitored by the physician with routine bloodwork for feminizing and adverse effects for every 3 months during the first year on HRT, followed by once every 6-12 months. Potassium levels are monitored if the patient is taking spironolactone.

Note that patients on estrogen are not being perpetually monitored for changes. Most timetables describing the effects of estrogen describe changes as occuring during timeframes such as the first 3-6 months or after 1-2 years. This is because these are the times where a patient typically visits her endocrinologist for monitoring. Certain effects can start earlier, or have continued effects that last for years after these time frames. These clinically available timeframes for changes are simply estimates.

Transgender girls typically have stable gender identities. GAHT can be started at as young as 12 in countries such as Holland, however the minimum age in most countries (such as in The United States) is 16 years of age. Parental consent is universally required for minors looking to start GAHT. Some transgender girls are lucky enough to experience puberty blockers prior to undergoing GAHT, avoiding the worst of the effects of a natural puberty. Availability of treatments will vary depending on the country and local laws or regulations. Some locations have strict age requirements regarding starting hormones, while other countries (particularly in Europe) allow treatment based on the individual maturity of the patient.

Anecdotally, starting estrogen later in life (age 50+) can result in less dramatic changes than starting earlier in life. That being said, many transgender women who have transitioned late in life have found happiness and satisfaction with their results. It is never too late to transition and find happiness in oneself.

Most transgender women will remain on estrogen therapy for the duration of their lives, unless forced to medically detransition due to external forces such as lack of access to treatment.

Transgender teenager girls typically have stable gender identities, and can be given estrogen hormonal therapy as early as age 16 after taking puberty blockers (though some trans kids are not lucky enough to have access to either treatments due to transphobia).

Effects of Estrogen

The exact presentation of effects that every patient on estrogen will experience will vary based on various factors, primarily genetics.

Breast Development

Similar to cisgender women, breast growth is a slow and painful process. It is recommended to invest in a sports bra to protect your breasts' sensitive development; a development that can take 2-5 years and slowly continue for another 10.

The nipples and areola will become bigger, darker, and more sensitive. Lactation is possible (though typically requires deliberate stimulation).

Breast growth typically starts aroun 3-6 months on estrogen, tapering off after around 2-3 years. Things such as taking progesterone or getting breast augmentation can help with obtaining larger breasts if unsatisfied with the results of estrogen (not everyone is lucky enough for estrogen to get them to the size they desire, though it is generally advised to wait a few years and see if you can grow your own).

Don't forget about underboob sweat.

Body Fat Redistribution

Estrogen causes new fats to be deposited in the thighs, butt, and hips. It reduces fat gathered in abdomen, causing waistline to become more defined below the ribs, and the belly to appear flatter and softer. The gathering of fat lower on the body results in a shifting center of gravity. Body fat redistribution can take around 3-6 months to become noticable, and 2-5 years to achive the maximum expected results (though, of course, lifestyle can change how fat appears on the body).

It can cause the the pelvic bone to rotate forward (known as anterior pelvic tilit), the degree of which will vary from person to person.

Body fat redistribution includes fat in the face, causing it to adjust to create more feminine features (though some trangender women still choose to pursue FFS). Estrogen causes the upper cheeks and lips puff up due to fat migration. It causes the neck, chin, and jawline to thin out. The color of the eyes may darken, and the skin & musculature around the eyes may result in alterations to eye shape; altering vision.

Changes in Body Odor, Sweat, Temperature

Switching from a testosterone dominated body to an estrogen dominated one can result in a lower body temperature. This, along with body fat redistribution can result in new sweat patterns and sweeter-smelling body odor. Sweat will become a full-body experience, rather than focused around the underarms and head.

Genital Changes

Estrogen causes the penis to become more sensitive. Like the rest of the body, it will cause it to become softer, smaller, and smell feminine. This can make sex more satisfying and gender affirming rather than distressing.

Random erections will cease. Shrinkage combined with lack of usage of the penis can result in atrophy, which can be mitigated through regularly inducing erections. The testicles and prostate will also shrink (which some may experience alongside mild pain). This can result in clear or nonexistant ejaculate. Decreased sperm production is variable.

The decrease in spontaneous erections typically occurs within the first 1-3 months, stopping entirely by 6 months. Changes in genital and orgasm sensitivity start around 3-6 months, reaching full effect around 1-2 years.

Change in libido is variable, though typically one's libido will decrease. If it does not increase over time, progesterone can help. If you are sexually active, do not treat GAHT as though it is birth control. If you are having the kind of sex that could result in pregnancy, and your partner does not want pregnancy to occur, please use actual contraceptives.

Hair

Decreased testosterone will result in thinner and lighter body hair. Terminal hairs will typically remain as they are, unless the subject shaves or engages in another relevant form of hair removal. The thinning of body and facial hair can start around 6-12 months on estrogen; and continue for 3+ years.

Estrogen stops the effects of male pattern baldness via strengthening head hairs. Lost hair is unlikely to grow back, though it may due to increased bloodflow to the scalp caused by estrogen. Hair loss caused by male pattern baldness stops (but rarely regrows) around 1-3 months.

Please note that like much of the effects of estrogen, the effects that will be had on hair will vary based on genetics.

Period Symptoms

Estrogen can cause period-like symptoms without having a uterus. This includes breast engorgement, mood swings, intestinal/abdominal cramping, bloating/water retention, PMS rage, acne, fatigue, changes in libido, changes in genital odor, and changes in appetite.

Reduced Muscle Mass

Testosterone makes it a lot easier to gain muscle mass. Having an estrogen-dominated body makes it much, much harder to gain/maintain muscle mass. The reduced muscle mass is linked to an increased percentage of overall body fat. This change typically occurs after 3-6 months; with the full effect typically being seen around 1-2 years after starting estrogen.

This comes with a significant decrease in strength. Tasks that may have previously seemed easy (such as opening jars or carrying heavy objects) will become more difficult. Decreased overall body mass is associated with a lower tolerance to things such as caffiene and/or alcohol. A reduced appetite associated with feeling fuller faster may occur.

Softer/Less Oily Skin

Estrogen can cause the skin to become iridescent and soft through increased production of collagen. The skin becomes thinner and less oily. This typically leads to a reduction in acne and dandruff.

This change typically occurs during the first 1-3 months; with the full effect of the change taking up to 3 years.

Smaller Hands/Feet

Removing the androgens from the body results in a decreasein water retention in ligaments and tendons, which would have previously made the skin less stretchy. Androgens also promote increased bloodflow to the feet. Estrogen causes the body's tendons to release that fluid and become more flexible.

As the skin gets softern and slimmer from estrogen, increasing its elasticity, this can result in going down a shoe size or two. One's foot arch may increase, due to the decreased bloodflow and water retention to the feet.

The fingers can get shorter, one's ring size can decrease. Fingernails will become thinner and more prone to breakage.

Ways to Take E

The method a patient uses will vary depending on personal preference, insurance coverage, and preexisting health conditions. Note that while some common name brands are mentioned, most types of estrogen are also available as lower-cost generics, though this will vary based on location. There is no clear evidence to suggest that any method has "better" or "worse" or faster results than any other method, though some people respond differently to different methods of estrogen administration.

Cream (Transdermal)

Gel (Transdermal)

Injections (Parenteral)

Estrogen treatments administered by needle are known as injections. The frequency of injections can vary based on personal preference and needs. A recommended dose for estrogen injections is estradiol valerate 5–20mg intramuscularly per 2 weeks or cypionate 2–10mg intramuscularly per week.

To reduce pain and injury, keep the following things in mind. Medication should be kept at room temperature. Keep your body warm and relaxed before and during an injection. When doing an injection, be sure to break through the skin quickly with the needle. Do not inject in the same spot over and over again, and change the location of the injections every time. After an injection, pull the needle straight out without wiggling it around. Do not massage the site of the injection. Ice or numbing cream can be applied to the injection site prior to cleaning it as a way to prepare for possible pain with injection.

Never share or reuse syringes or needles. Use new needles and syringes every time you inject. Most pharmacies sell syringes and needles. Free needles can sometimes be found at a needle exchange program. Do NOT dispose of needles in the recycling. Do not let needles touch any surfaces (outside of when it is being used to draw up or inject medication) to prevent infection.

Peak estrogen levels can be measured 24 – 48 hours after injection. Trough levels can be measured immediately before injection.

Autoinjectors can be useful for people who experience anxiety regarding the usage of needles.

Note that if you experience significant redness or swelling at the injection site that you may be allergic to the oil-based solution that the estrogen is suspended in, and may have to discuss alternatives with your provider.

Note that needle sizes are measured in a unit known as gagues. The higher the number, the smaller the gague, and therefore the smaller size the needle is. For example, a needle that is 22 gague is physically much smaller needle than a needle that is 18 gague. Having a bigger gague needle makes it easier to draw up liquid from a vial. Having a smaller gague needle makes it less painful to inject medication into the body.

Intramuscular

Intramuscular (i.m.) injections are injected directly into the muscle. Intramuscular injections typically require the help of a doctor, friend, or family member to administer. Intramuscular injections can be more painful than subcutaneous injections. Intramuscular injections can go into the thighs (aim for halfway between your knee and your hip on the outer part of your thigh) or buttocks (aim for where the top of your pants pocket would be to avoid hitting a sciatic nerve). If you choose to inject into the thighs, you will most likely need help from another person. If you feel an extreme amount of pain during an intramuscular injection, immediately remove the needle (pull it straight out), as this indicates that you hit a nerve.

  1. Make sure to gather all of your supplies before injecting. The required supplies consists of an alcohol wipe or pad or rubbing alcohol (two alcohol wipes are ideal), the vial of medication, a syringe, two needles (a single 18 or 20 gauge needle to draw up medication & a single 22 or 23 gauge needle for the injection), cotton ball or gauze, and a puncture-proof sharps container (or a hard plastic detergent bottle or milk jug) to safely dispose of needles. Check the expiration date, dosage, and concentration of your medication (double and triple check this throughout the process to ensure that you are getting the correct dose).

  2. Find a spot that is well lit, clean, and has a lot of space available for your supplies. Wash your hands with either antibacterial soap and water or an alcohol-based gel aka hand sanitizer (if soap and water are not available). Hold up the bottle of medication to the light. If it is cloudy, or there are little bits floating in it, don't use it (it is expired).

  3. Take the cap off the medication vial. Clean the rubber stopper with an alcohol wipe for 15-20 seconds. Let it dry. Clean the injection site (thigh or butt) with another alcohol pad or pour alcohol over the area. Clean the area on your body where you intend to do the injection with a circular motion from the center moving out. Let it dry.

  4. Secure the larger gauge needle for drawing up medication on the syringe. Pull the needle cover straight off the syringe. Pull back the plunger to the number on the syringe that matches your dose. Insert the needle straight down into the bottle (through the rubber stopper), and push the plunger of the syringe all the way down, injecting air into the vial.

  5. Turn the vial upside down (keep holding it and the syringe steadily). Slowly pull back the plunger to fill the syringe with medication, and check to make sure you have the correct dosage. Gently tap the syringe with your fingers until the larger air bubbles rise to the top. Slowly push the plunger up to force the air bubbles out. After the air bubbles are out, slowly pull the plunger down to the number corresponding with the correct dosage of medication.

  6. Dispose of the drawing up needle (put it in the sharps box). Replace the drawing up needle with the smaller gauge injection needle.

  7. Pull the skin taught around the injection site. Quickly and firmly push the needle straight through the skin (at a 90° angle) and into the muscle. If you experience extreme pain while doing this, immediately remove the needle, as this indicates you hit a nerve. Slowly push the plunger to inject the hormones. Wait 5 seconds, then let go of the skin that was being pulled taut. Pull the syringe straight back out to remove from skin.

  8. Safely dispose of injection needle (put it in the sharps box along with the syringe). If bleeding after the injection, use a cotton ball or tissue to clean up. Apply a band-aid as necessary. Wash hands with warm water and soap. Keep sharps container out of reach of children.

Subcutaneous

Subcutaneous injections are injected just under the skin. It is easier to self-inject a subcutaneous injection, as opposed to intramuscular ones. Subcutaneous injections can go in the stomach (below and away from the bellybutton, avoid boney areas), the side or back of the upper arms (aim for below the shoulder and above the elbow), and thighs (aim for halfway between your knee and your hip on the outer part of your thigh). The risk of hitting a nerve is significantly reduced compared to with intramuscular injections, as subcutaneous needles are much smaller.

The best type of syringe to use is one that is 1cc (or 1 milliliter). Larger syringes make it more difficult to do subcutaneous injections with oily substances such as hormonal medication. A 1.5 inch 20 gauge needle is optimal for drawing up the liquid medication. A 0.5 inch 30 gauge needle is optimal for injecting the medication into the body. Some healthcare providers will give patients slightly larger gauge needles, such as 22 gauge, which can be slightly more painful when injecting.

  1. Make sure to gather all of your supplies before injecting. The required supplies consists of an alcohol wipe or pad or rubbing alcohol (two alcohol wipes are ideal), the vial of medication, a syringe, two needles (a single 1.5 inch 20 gauge needle for drawing up medication & a 0.5 inch 30 gauge needle for injecting), and a sharps container (or a hard plastic detergent bottle or milk jug) to safely dispose of needles. Check the expiration date, dosage, and concentration of your medication.

  2. Find a spot that is well lit, clean, and has a lot of space available for your supplies. Wash your hands with either antibacterial soap and water or an alcohol-based gel aka hand sanitizer (if soap and water are not available). Hold up the bottle of medication to the light. If it is cloudy, or there are bits floating in it, don't use it (its expired).

  3. Take the cap off the medication vial. Clean the rubber stopper with an alcohol wipe for 15-20 seconds. Let it dry. Clean the injection site (thigh, butt, or upper arm) with another alcohol pad or pour alcohol over the area. Clean the area on your body where you intend to do the injection with a circular motion from the center moving out. Let it dry.

  4. Secure the larger gauge needle for drawing up medication on the syringe. Pull the needle cover straight off the syringe. Pull back the plunger to the number on the syringe that matches your dose. Insert the needle straight down into the bottle (through the rubber stopper), and push the plunger of the syringe all the way down, injecting air into the vial.

  5. Turn the vial upside down (keep holding it and the syringe steadily). Slowly pull back the plunger to fill the syringe with medication, and check to make sure you have the correct dosage. Gently tap the syringe with your fingers until the larger air bubbles rise to the top. Slowly push the plunger up to force the air bubbles out. After the air bubbles are out, slowly pull the plunger down to the number corresponding with the correct dosage of medication.

  6. Dispose of the drawing up needle (put it in the sharps box). Replace the drawing up needle with the smaller gauge injection needle.

  7. Pinch an inch of skin at the injection site. Quickly and firmly insert needle just under the skin. The needle can be inserted straight up and down, or at a 45⁰ angle. If you experience extreme pain while doing this, immediately remove the needle, as this indicates you hit a nerve. Slowly push the plunger to inject hormones. Wait 5 seconds. Pull the syringe straight back to remove from skin.

  8. Safely dispose of injection needle (put it in the sharps box along with the syringe). If bleeding after the injection, use a cotton ball or tissue to clean up. Apply a band-aid as necessary. Wash hands with warm water and soap. Keep sharps container out of reach of children.

Oral Tablets

A recommended dose for oral conjugated estrogens is 2.5–7.5mg per day. A recommended dose for oral 17-beta estradiol is 2–6mg per day.

Taking estrogen via pill is not recommended for those with preexisting liver or blood clotting issues.

Topical Patches (Transdermal)

A recommended dose for topical estradiol patches is 0.1–0.4mg/2X week.

Progesterone

Progesterone is a hormone that is often taken alongside estrogen as a part of HRT. It can increase bone density, have a positive impact on sleep, reverse decreased appetite that may be caused by estrogen, help reduce male pattern baldness, help reduce oily skin, and help with increasing breast growth.

Progesterone can reverse a sex drive lost via just taking estrogen on its own (if it happens to disappear without return).

Spironolactone (Anti-Androgen)

Spironolactone is a hormone blocker that blocks testosterone. This is typically taken alongside estrogen to boost and complement its effects. 100 – 200 mg/day (up to 400 mg) of spironolactone is typically recommended.

Spironolactone can have negative impacts on one's working memory.

Cyproterone acetatea is another type of anti-androgen. 50–100mg per day is recommended.

Resources About Spironolactone

Resources About Progesterone